The Face Essentials

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The field of minimally invasive cosmetic dermatology has grown exponentially over the last three years,’ says Dr. Charles Crutchfield, Clinical Associate Professor of Dermatology at the University of Minnesota Medical School. ‘When the field first started 15 to 20 years ago, there were some very good companies, such as NeoStrata, which made high-quality products that did a very nice job. That was helpful to the development of the field because it gave cosmetic dermatology patients confidence in the results that could be obtained.’

He says as time went on medicines were developed that allowed even better rejuvenation of the face and for Dr. Crutchfield the real champion was Botox. ‘Physicians started using Botox around 1994, and the nice thing with the product is it’s been in use around the world for about 10 years now and tens of millions of treatments have been performed with no lasting adverse affects. This is a high-quality product that also produces dramatic results at affordable prices and has an excellent safety profile.’
Botox is a genetically engineered and purified enzyme that acts to relax muscles in a non-permanent manner.
Dr. Crutchfield says this is the reason it can be so effective if you create lines in your face from being an expressive person or smiling or frowning a lot; it can relax the muscles that cause unwanted lines and wrinkles so they fade away.
‘One of the concerns many patients have is about the length of time Botox lasts,’ he explains. ‘They say, ‘Well, I don’t want to use Botox because I need to repeat it two to three times a year.’ But different patients actually use Botox differently. Some patients use it just before a big event such as a wedding, school reunion or special family photograph. Others use it two to three times a year to maintain a line-free state. I explain to my patients that even though Botox doesn’t last forever, neither does a nice haircut. It’s really all about maintenance.’
The areas Botox works very well in are: the forehead, the frown lines between the eyes, the smile lines at the sides of the eyes and also to some degree smoker’s lines around mouth. It lasts four to six months and most of Dr.

Crutchfield’s patients come back regularly for treatment.

He explains the more often patients have it the less they need to be treated: ‘I have patients from late 1990s who now only require treatment once a year.’
There are some short-term side effects that may occur in a small percentage of people. Dr. Crutchfield says these include slight bruising, short-lived mild headaches and in about one in a thousand cases a mild eyelid droop that can last a week or two. He adds some patients may complain of mild cold-like symptoms for a day or two but this is very rare, occurring in only one in 500 patients.
Unfortunately a lot of the medicines that are used to treat lines and wrinkles in motion (like Botox) will help with lines at rest to a small degree but not completely. As a result a complementary treatment is needed that utilizes filling agents to smooth out the lines and winkles that are constantly present.
Dr. Crutchfield says there are a wide variety of agents that work exceptionally well in association with Botox. One of these is Restylane.
Restylane is a sugar-based gel that goes by the chemical name hyaluronic acid. Hyaluronic acid is a natural product that occurs in human skin and is one of the natural fluids found in our bodies. It is one of the structural products that gives cells support, for example it gives shape to the human eye.
Dr. Crutchfield says that because it is a natural substance the incidence of allergy to hyaluronic acid is almost non-existent: ‘Restylane doesn’t need allergy testing because it doesn’
t have any protein content.
‘Hyaluronic acid is naturally produced in the body and naturally broken down. Now companies have learned to cross-link the molecules so it doesn’t break down as rapidly. As a result hyaluronic acid can last from six to 12 months, which is much longer than protein fillers.
‘Some of my patients say they would prefer some sort of permanent filler to Restylane, which only lasts a year. But it is important for patients to know that the human face changes over time. If you put something permanent into it, the result may look nice now but it could look quite odd in five years time. The product
may not change as they do.’
Dr. Crutchfield says another important factor is that over time the lower half of the face (from the nose down, around the mouth and including the lips) loses volume. He explains psychological studies have been performed trying to figure out how people identify someone as looking old: ‘The researchers do this by working out how much volume has been lost in the human face. A natural, youthful appearance is associated with a round, fuller face and this can therefore be restored with a product such as hyaluronic acid.
‘The filling agents are almost miraculous when used for filling lines on the cheeks, between the nose and the corner of the mouth, lines around the mouth and frown lines between the eyebrows, and are exceptional at rejuvenating and repairing the lips. I tell all
my patients they can have lips that look like they were when they were 18.’
‘I prefer hyaluronic acid products because they go in smoothly, don’t cause allergic reactions later, last longer than most other fillers and have a lower side effect profile.’
He says the only caveat is that the most important thing about any cosmetic dermatological treatment is not
necessarily the product being used but the physician
administering it.
‘Nothing beats experience. Oftentimes patients will overlook this most important fact and make a selection based on price alone. In fact price should actually be only one of many considerations. www.safebotox.com is a website that provides a whole list of considerations and questions that should be considered.
‘Both Botox and Restylane are extremely effective and
very safe products, and the bottom line is that patients
love the results.’
The onset of facial lines and wrinkles are an inevitable part of growing older. But when our expression lines start to detract from our appearance, it’s time for many of us to turn to the raft of products and minimally invasive treatments now available to help improve our appearance. Nonsurgical facial rejuvenation encompasses a host of different treatments. ‘The field of minimally
invasive cosmetic dermatology has grown exponentially over the last three years,’ says Minneapolis dermatologist Charles Crutchfield MD, Clinical Associate Professor of Dermatology at the University of Minnesota Medical School. Along with this surge in growth has come a mass of information and an increase in the number of practitioners who perform a range of treatments. This can make it difficult to know which treatment options you require as well as who you should see to perform them.
Some of the more common treatments work effectively as stand-alone procedures, and many can be combined for even more effective results.
Botox
As you age, facial lines and wrinkles start to appear from repeated muscle contractions caused by frowning, smiling, and laughing. Botox (Botulinum Toxin Type A) is a genetically engineered and purified enzyme that is injected in minute quantities to relax the muscles that cause the unwanted lines and wrinkles.
Botox works well on the forehead, the frown lines between the eyes, crow’s feet, marionette lines, chin creases and neck bands, and also, to some degree, on smoker’s lines around mouth. The results last from three to six months.
Restylane
Restylane is a filling agent that is designed to smooth out the lines and wrinkles that can be seen when the face is at rest. It’s a sugar -based gel that goes by the chemical name hyaluronic acid. Hyaluronic acid is a natural product that occurs in human skin and is one of the natural fluids found in our body.
Over time, the lower half of the face loses volume. Restylane is used to fill lines on the cheeks, between the nose and the cor
ner of the mouth, lines around mouth, and to rejuvenate and repair the lips. Treatment with hyaluronic acid can last six to 12 months before being absorbed by the body. This is much longer than protein filler alter natives.
‘I prefer hyaluronic acid products because they can be injected smoothly, they don’t cause allergic reactions, they last longer than most other fillers and they have a lower side-effect profile,’ says Dr. Crutchfield.
Often a combination approach is adopted. Botox is first used to smooth the lines, and then filling agents employed to fill the deeper crevices and wrinkles.
IPL
Intense pulsed light (IPL) therapy involves a laser-like device that uses filters to produce a broad spectrum of light to treat different conditions. IPL is an effective treatment for wrinkles, evening out skin tone, removing unwanted hair and correcting some sun damage. Little downtime is involved. For optimum results, a series
of treatments is usually required. The skin’s appearance will continue to improve after the treatments have ceased due to further collagen rebuilding.

Dr. Crutchfield explains, ‘The newer generation IPL devices tend to have a better effect within their desired target range. The second generation of IPL devices should be introduced within the next six

months. They are designed to treat redness, freckling, veins, and changes in the skin associated with chronic sun exposure.’
Peels Alpha-hydroxy acid treatments for the skin are the fundamental tool that Dr. Crutchfield uses for skin fitness
and rejuvenation. ‘We have tried a lot of different lines but we now use the NeoStrata line because we consider it to be the gold standard in the field. NeoStrata actually invented peels and they have now come out with a new platinum line to address specific concerns,’ he reveals.
He adds that peel programs require a commitment to a skin fitness regimen that will last over six months: ‘We usually design and initiate a home program for our patients and have them come into the clinic twice monthly for in-office treatments. The treatments are graduated so the strength of the alpha-hydroxy acid we use increases over time as the patient’s skin can accommodate it.’
Microdermabrasion
This is a mild procedure in which fine crystals are projected onto the skin to treat fine lines, some pigmentation spots, acne and acne scars. No downtime is required and several treatment sessions will be needed.
‘I am not a big fan of microdermabrasion alone because I believe it doesn’t do everything it’s purported to do,’ says Dr. Crutchfield. ‘However, we do exploit the exfoliative properties of microdermabrasion when we design a skin-care program using NeoStrata alpha-hydroxy products because these products penetrate more readily after a microdermabrasion treatment.’
Ultra-moisturizing medical facials
A new treatment Dr. Crutchfield is currently investigating is the ultra-moisturizing medical facial. This treatment uses a combination of collagen and hyaluronic acid to perform an intense, moisturizing facial treatment. Essentially, the dead skin is exfoliated and an ultra-rich hydrating gel is applied to the face. The treatment takes away superficial and fine wrinkles and produces almost a silky smooth, soft feeling to the skin. The result will last from two to three days initially, and over time can have significantly longer effects.
‘We recommend that patients have this facial once a week for four to eight weeks. Our experience now is that patients who come in and have it done on a Thursday or Friday before a big weekend find their skin looks fantastic and feels even better. By doing it weekly, the effects will last longer and longer. We also combine
this with other skincare programs,’ he says.
Mesotherapy
Mesotherapy is a technique that can offer dramatic results. It can be used to smooth cellulite, and for body sculpting to remove unwanted deposits of adipose (fat) tissue.
‘Mesotherapy body sculpting can be used to remove unwanted pockets of fat on the lower tummy, love handles, saddlebags, flanks, mid back (rolls just under the bra), double chin, and bags under the eyes. Generally speaking, this approach involves tiny injections given every two weeks. Usually, success is achieved in only two to six treatments. We are achieving some remarkable results with mesotherapy,’ he explained.
Dr. Crutchfield advises patients to beware of buying packaged treatments. ‘Patients should be wary of buying packages unless the seller of the packaged series of treatments will offer a refund if they are not satisfied. Some spas and clinics will pressure the patient to buy a series of treatments and, if the patient is unhappy, they won’t refund their money. This should certainly be a warning sign.’
He also believes an important factor with any cosmetic dermatological treatment is the physician administering it, not just the product being used. ‘Nothing beats experience,’ he says. ‘Oftentimes patients will overlook this most important fact and make a selection based on price alone. Price should be only one of many considerations to ensure a good result. A website that provides a whole list of considerations and questions that should be assessed when deciding to have a treatment is www.safebotox.com.’